Provider Demographics
NPI:1568691863
Name:RUFFIN, KATHLEEN ANN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2855 E. BROWN RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213
Mailing Address - Country:US
Mailing Address - Phone:480-807-2636
Mailing Address - Fax:480-924-6452
Practice Address - Street 1:2855 E. BROWN RD
Practice Address - Street 2:SUITE 15
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213
Practice Address - Country:US
Practice Address - Phone:480-807-2636
Practice Address - Fax:480-924-6452
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH6378124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist